The root of all evils when it comes to blister formation is moisture. As the humidity rises, moisture content in the air also rises, leading to increased perspiration and friction between feet, socks and shoes! Blister formation occurs when friction and moisture combine separating the top layer of skin (epidermis) from the layer below (dermis) allowing the area to fill with fluid. Often times, the fluid is clear, but can be bloody or infection filled. For simplicity, we will address the most common form of blistering on the feet; those filled with clear fluid.
No one is immune to blistering and time again, athletes pull over at the medical tent during their marathon or charity-walking event, for blister care. In the summer month, sandals tend to induce blisters between toes, or on the sole of the feet, as motion of the foot isn’t well controlled in a sandal and that extra motion combined with moisture, creates friction and blister formation. Depending on the location of the blister, some are much more painful than others and can inhibit daily activities. The following “Blister Tips” address some of the myths in treating blisters and will guide you towards appropriate treatment.
1. Don’t pop blisters at home! It can be rather tempting to pop a fresh blister and relieve the pressure by expressing the fluid, but that’s not recommended. Blisters, by nature, contain sterile fluid, meaning that there is no bacterium inside and infection is a remote possibility. If you decide to pop a blister with a needle that you might have “sterilized” in your bathroom, you run the risk of inducing infection. Not only from the needle, but also because now you’ve exposed this sterile environment to the outside environment. Resist the urge to pop your blister and allow your body to resorb blister fluid on its own.
2. If I shouldn’t pop blisters at home, why does the medical staff pop them during a race? In an acute setting, such as during a marathon, blisters are typically popped by the medical staff. The reason: immediate relief of the excess pressure allows runners to continue through the remainder of the competition. The medical staff cleans the skin surrounding the blister with alcohol, uses a sterile needle to puncture the skin, and drains fluid out at it’s lowest point of gravity. Although the method isn’t perfect, and not recommended at home, the medical staff does their best to prevent infection while providing immediately relief for the athlete.
3. What to do if your blister pops on its own: As mentioned above, once your blister is exposed to the outside environment, infection becomes a possibility as there is now an entry point for bacterium. When this occurs, you need to do your best to keep the blistered area extremely clean. Using warm water and soap is sufficient, making sure to dry the area thoroughly and protect it using a band-aid that covers the entire blister. Avoid using hydrogen peroxide to cleanse the area. If dead skin remains, leave the skin in place, as it is still capable of providing a barrier for infection while providing a good environment for new skin to grow underneath.
4. Get your feet measured for shoe-size accuracy. As we’ve mentioned, blisters are mainly caused by friction combined with moisture. Shoes that are tight in the wrong places can cause recurrent irritation and frequent blistering. Getting your feet measured for an accurate shoe size can make a difference if you’ve been wearing the wrong size! Adjusting your running shoes to fit your feet may also increase your distance and comfort level while engaging in activity.
5. Blisters can occur separate from friction and moisture. Blisters that are small in size and seem to continually appear for unexplained reasons may indicate a problem separate from friction and moisture. Check the other areas of your feet looking for scaly skin on the soles and heels. If you find areas of scaly skin, it is likely that you have a fungal infection and the blister formation is a result of that. Contact your Podiatrist for an appointment, as they can treat your fungal infection quickly with topical medications!
6. Prevention is your best option! The goal in prevention is to decrease friction and eliminate moisture, as those are the most common predisposing factors. As discussed wearing shoes that fit your foot size is important in decreasing areas of pressure where friction is imminent. In addition, keeping your feet dry and wearing socks that allow the feet to breath, versus cotton socks that hold in moisture, is very important. Finally, treating any underlying conditions such as fungus that may be causing blister formation will help tremendously in prevention.
Monday, May 31, 2010
Wednesday, May 19, 2010
How Stressed is Your Stress Fracture?
When a Podiatrist diagnosis a patient with a stress fracture, patients only hear the “fracture” part of the diagnosis. However, the “stress” part of that statement is extremely important and delineates a stress fracture from other types of fracture in its mechanism of injury and prognosis for recovery.
Stress fractures differ from other fractures in that they are not caused by acute trauma, but rather repetitive trauma and stress to the bone. Therefore, patients suffering from a stress fracture can relay no history of injury to the area. They are more commonly seen in athletes and especially runners who are constantly demanding their bodies to perform. Typically, stress fractures start as a small break in the outer (cortex) portion of the bone leading to inflammation within the bone and pain for the patient. If a stress fracture is not detected in its early stages and the patient continues on with normal activity, the size of the break can increase resulting in fracture completely across the bone. Although the most likely location for stress fractures in the foot are the 2nd and 3rd metatarsals (long bones), they can be found in the leg as well, just less frequently.
Signs to look for when you are suspect for a stress fracture include pain that is increased with activity and that may or may not be accompanied by swelling. The pain will be progressive, meaning that with each day it seems to increase, and it will become painful to the point where you will begin to cut back on your athletic and normal daily activity. As mentioned before, you may not remember injuring yourself, as stress fractures don’t present themselves in association with acute trauma, thus symptoms, rather than physical presentation becomes important. If a stress fracture becomes a possibility in the back of your mind, it’s best to withdrawal from activity and seek out your local Podiatrist.
After ruling out other possibilities for the cause of your recent pain, your Podiatrist will take x-rays to evaluate the bones of the foot. This is where the diagnosis for a stress fracture becomes tricky: a stress fractures’ break in the cortex of the bone may not appear on x-ray until 10 to 14 days after the initial break. In the early stages there is not enough bone resorption (washing away of bone in the area of the fracture) to be picked up by plain x-ray. Therefore, despite what the x-ray may or may not show, the Podiatrists index of suspicion for a stress fracture, combined with your clinical symptoms and history, will likely be the basis of your diagnosis. In some cases you may be given a prescription for an MRI or CT scan which can look closer at the bone and be able to pick up a stress fracture from day one, however, this is not always necessary.
The treatment of choice in patients with stress fractures is rest and immobilization, meaning you will likely need to wear a CAM (controlled ankle motion) walker in addition to discontinuing athletic activity. A CAM is a removable boot that should be worn as much as possible, but can be removed at bedtime for comfort. It is used initially because it decreases motion and stress on the foot while allowing patients to walk while wearing it, without the use of crutches. When patients are compliant and wear the CAM as instructed, it is usually sufficient enough to allow healing of the bone. More aggressive forms of immobilization such as casting can be utilized, but are reserved for patients who don’t comply with the initial treatment attempts using a CAM. Keep in mind, the longer you continue normal activity on the stress fracture the higher your risk of breaking the bone completely, which inevitably leads to a longer recovery time. Therefore, it is in your best interest to limit activity and immobilize the foot!
Your clinical symptoms will indicate to your Podiatrist when appropriate healing has taken place and transition back to a sneaker with a slow increase in your activity is safe. However, you should plan on about 4-6 weeks of immobilization, as that is how long it will take for your pain to decrease and for the defect in the bone to fill in with new bone and fibrous tissue. Certainly you can take ibuprofen for pain as needed, as well as apply ice to the area in attempt to keep the swelling down, but rest and immobilization are key!
Unfortunately, there isn’t much you can to do to prevent a stress fracture, but there are things you can do to cut down your risk. If you already have a workout routine and you plan to increase your level of activity or distance running, do so slowly. Changes and increases in activity often bring on a stress fracture, as your body is not adequately prepared. If you don’t have a consistent routine, but want to get moving, start slowly and with short distances, building up to your ultimate goal. In both situations your bones need a chance to adjust to the increased stresses and if given adequate time to do so, you decrease your risk of injury.
Stress fractures differ from other fractures in that they are not caused by acute trauma, but rather repetitive trauma and stress to the bone. Therefore, patients suffering from a stress fracture can relay no history of injury to the area. They are more commonly seen in athletes and especially runners who are constantly demanding their bodies to perform. Typically, stress fractures start as a small break in the outer (cortex) portion of the bone leading to inflammation within the bone and pain for the patient. If a stress fracture is not detected in its early stages and the patient continues on with normal activity, the size of the break can increase resulting in fracture completely across the bone. Although the most likely location for stress fractures in the foot are the 2nd and 3rd metatarsals (long bones), they can be found in the leg as well, just less frequently.
Signs to look for when you are suspect for a stress fracture include pain that is increased with activity and that may or may not be accompanied by swelling. The pain will be progressive, meaning that with each day it seems to increase, and it will become painful to the point where you will begin to cut back on your athletic and normal daily activity. As mentioned before, you may not remember injuring yourself, as stress fractures don’t present themselves in association with acute trauma, thus symptoms, rather than physical presentation becomes important. If a stress fracture becomes a possibility in the back of your mind, it’s best to withdrawal from activity and seek out your local Podiatrist.
After ruling out other possibilities for the cause of your recent pain, your Podiatrist will take x-rays to evaluate the bones of the foot. This is where the diagnosis for a stress fracture becomes tricky: a stress fractures’ break in the cortex of the bone may not appear on x-ray until 10 to 14 days after the initial break. In the early stages there is not enough bone resorption (washing away of bone in the area of the fracture) to be picked up by plain x-ray. Therefore, despite what the x-ray may or may not show, the Podiatrists index of suspicion for a stress fracture, combined with your clinical symptoms and history, will likely be the basis of your diagnosis. In some cases you may be given a prescription for an MRI or CT scan which can look closer at the bone and be able to pick up a stress fracture from day one, however, this is not always necessary.
The treatment of choice in patients with stress fractures is rest and immobilization, meaning you will likely need to wear a CAM (controlled ankle motion) walker in addition to discontinuing athletic activity. A CAM is a removable boot that should be worn as much as possible, but can be removed at bedtime for comfort. It is used initially because it decreases motion and stress on the foot while allowing patients to walk while wearing it, without the use of crutches. When patients are compliant and wear the CAM as instructed, it is usually sufficient enough to allow healing of the bone. More aggressive forms of immobilization such as casting can be utilized, but are reserved for patients who don’t comply with the initial treatment attempts using a CAM. Keep in mind, the longer you continue normal activity on the stress fracture the higher your risk of breaking the bone completely, which inevitably leads to a longer recovery time. Therefore, it is in your best interest to limit activity and immobilize the foot!
Your clinical symptoms will indicate to your Podiatrist when appropriate healing has taken place and transition back to a sneaker with a slow increase in your activity is safe. However, you should plan on about 4-6 weeks of immobilization, as that is how long it will take for your pain to decrease and for the defect in the bone to fill in with new bone and fibrous tissue. Certainly you can take ibuprofen for pain as needed, as well as apply ice to the area in attempt to keep the swelling down, but rest and immobilization are key!
Unfortunately, there isn’t much you can to do to prevent a stress fracture, but there are things you can do to cut down your risk. If you already have a workout routine and you plan to increase your level of activity or distance running, do so slowly. Changes and increases in activity often bring on a stress fracture, as your body is not adequately prepared. If you don’t have a consistent routine, but want to get moving, start slowly and with short distances, building up to your ultimate goal. In both situations your bones need a chance to adjust to the increased stresses and if given adequate time to do so, you decrease your risk of injury.
Friday, May 14, 2010
To Run With or Without Shoes…That is The Question!
In recent years, much discussion has surrounded the topic of Barefoot Running. The benefits versus the risks of running barefoot have the medical community divided on which is “best” and for which running populations. International athletes suck as Abebe Bikila of Ethiopia have successfully competed in long-distance running events without the aid of shoes; if he can run without shoes, why can’t the rest of us?
It is not so much that you can’t become a “barefoot runner,” but the more important question becomes, is it safe? What are the risks and benefits of running without shoes?
Running barefoot has come into favor in recent years because runners and sports science researcher alike believe that running barefoot allows a runner to expend less energy in addition to decreasing their risk of acute injury, such as ankle sprains. Proponents believe that the risk of injury increases with shoe-wear due to slowed proprioceptive feedback from the foot to the brain. Proprioceptive feedback is a message sent from the foot up to the brain that tells your foot that it is on the ground and in which position. Without shoes, there is no interference from the material of the shoe and the feedback from the foot to the brain is faster and more efficient, thus your body can adjust to uneven surfaces quicker, preventing injury.
The theory behind a decrease in energy expenditure in the athletes running barefoot has no substantial research behind it, but theorist believe it may have something to do with proprioceptive feedback in addition to the simultaneous use of foot and leg muscles. It is believed that when running barefoot an athlete must use all the muscles in their foot and leg to run, thus no one muscle must work harder than it was intended, as they believe is the case in those running with shoes. They say that shoes and “high-tech” athletic sneakers prohibit certain muscles in the legs from working at their maximum capacity, forcing other muscles to work harder, which could lead to the increase in energy expenditure.
Proponents of running with shoes believe that without the use of supportive shoes and/or orthotic devices during running, the musculature of the foot and leg is incorrectly aligned or stretched. Muscles function at their maximum capacity, with the least energy expenditure while in their correct anatomical alignment, so unless a person has a “perfect” foot, chances are their muscles are not functioning at the top of their game! Orthotics and shoes to some extent, place the foot and leg in their “neutral position,” aligning the muscles, tendons and ligaments correctly so as to allow them to exert their maximum benefit.
In terms of injury, it remains to be seen whether more acute injuries are suffered with or without shoes because there simply isn’t enough research to support one side or the other. However, it has been proven that the skin on the soles of the feet is 20 times thicker than any other skin on the body. This may make the sole of the foot more resistant to injury over other areas of the body, but it certainly doesn’t make it immune to injury! Those against barefoot running can show clear evidence to support an increase in puncture wounds to the soles of the feet in athletes running without shoes. Objects that could be encountered while running without shoes, such as rocks, glass and nails still have the potential to cause serious injury and debilitation to the soles.
Certainly if you suffer from peripheral neuropathy, as a complication of diabetes, alcoholism or other inducing factors, shoes should be worn at all times. In patients with neuropathy, infarct on the plantar aspects of the foot may go undetected due to lack of sensation, and further complications such as infection and non-healing wounds are imminent!
Adjusting to barefoot running, should you bravely attempt it, may take up to 4 weeks, at which time the skin on the plantar surfaces of your feet with become thicker and more adept to handling new terrain. You should begin by walking barefoot as much as possible, and slowly work your way into jogging, and eventually running when you feel comfortable.
No matter which thought process you follow, exhibit safety. Carefully weigh the options, know which is best for you, and get running!
In recent years, much discussion has surrounded the topic of Barefoot Running. The benefits versus the risks of running barefoot have the medical community divided on which is “best” and for which running populations. International athletes suck as Abebe Bikila of Ethiopia have successfully competed in long-distance running events without the aid of shoes; if he can run without shoes, why can’t the rest of us?
It is not so much that you can’t become a “barefoot runner,” but the more important question becomes, is it safe? What are the risks and benefits of running without shoes?
Running barefoot has come into favor in recent years because runners and sports science researcher alike believe that running barefoot allows a runner to expend less energy in addition to decreasing their risk of acute injury, such as ankle sprains. Proponents believe that the risk of injury increases with shoe-wear due to slowed proprioceptive feedback from the foot to the brain. Proprioceptive feedback is a message sent from the foot up to the brain that tells your foot that it is on the ground and in which position. Without shoes, there is no interference from the material of the shoe and the feedback from the foot to the brain is faster and more efficient, thus your body can adjust to uneven surfaces quicker, preventing injury.
The theory behind a decrease in energy expenditure in the athletes running barefoot has no substantial research behind it, but theorist believe it may have something to do with proprioceptive feedback in addition to the simultaneous use of foot and leg muscles. It is believed that when running barefoot an athlete must use all the muscles in their foot and leg to run, thus no one muscle must work harder than it was intended, as they believe is the case in those running with shoes. They say that shoes and “high-tech” athletic sneakers prohibit certain muscles in the legs from working at their maximum capacity, forcing other muscles to work harder, which could lead to the increase in energy expenditure.
Proponents of running with shoes believe that without the use of supportive shoes and/or orthotic devices during running, the musculature of the foot and leg is incorrectly aligned or stretched. Muscles function at their maximum capacity, with the least energy expenditure while in their correct anatomical alignment, so unless a person has a “perfect” foot, chances are their muscles are not functioning at the top of their game! Orthotics and shoes to some extent, place the foot and leg in their “neutral position,” aligning the muscles, tendons and ligaments correctly so as to allow them to exert their maximum benefit.
In terms of injury, it remains to be seen whether more acute injuries are suffered with or without shoes because there simply isn’t enough research to support one side or the other. However, it has been proven that the skin on the soles of the feet is 20 times thicker than any other skin on the body. This may make the sole of the foot more resistant to injury over other areas of the body, but it certainly doesn’t make it immune to injury! Those against barefoot running can show clear evidence to support an increase in puncture wounds to the soles of the feet in athletes running without shoes. Objects that could be encountered while running without shoes, such as rocks, glass and nails still have the potential to cause serious injury and debilitation to the soles.
Certainly if you suffer from peripheral neuropathy, as a complication of diabetes, alcoholism or other inducing factors, shoes should be worn at all times. In patients with neuropathy, infarct on the plantar aspects of the foot may go undetected due to lack of sensation, and further complications such as infection and non-healing wounds are imminent!
Adjusting to barefoot running, should you bravely attempt it, may take up to 4 weeks, at which time the skin on the plantar surfaces of your feet with become thicker and more adept to handling new terrain. You should begin by walking barefoot as much as possible, and slowly work your way into jogging, and eventually running when you feel comfortable.
No matter which thought process you follow, exhibit safety. Carefully weigh the options, know which is best for you, and get running!
To Run With or Without Shoes…That is The Question!
In recent years, much discussion has surrounded the topic of Barefoot Running. The benefits versus the risks of running barefoot have the medical community divided on which is “best” and for which running populations. International athletes suck as Abebe Bikila of Ethiopia have successfully competed in long-distance running events without the aid of shoes; if he can run without shoes, why can’t the rest of us?
It is not so much that you can’t become a “barefoot runner,” but the more important question becomes, is it safe? What are the risks and benefits of running without shoes?
Running barefoot has come into favor in recent years because runners and sports science researcher alike believe that running barefoot allows a runner to expend less energy in addition to decreasing their risk of acute injury, such as ankle sprains. Proponents believe that the risk of injury increases with shoe-wear due to slowed proprioceptive feedback from the foot to the brain. Proprioceptive feedback is a message sent from the foot up to the brain that tells your foot that it is on the ground and in which position. Without shoes, there is no interference from the material of the shoe and the feedback from the foot to the brain is faster and more efficient, thus your body can adjust to uneven surfaces quicker, preventing injury.
The theory behind a decrease in energy expenditure in the athletes running barefoot has no substantial research behind it, but theorist believe it may have something to do with proprioceptive feedback in addition to the simultaneous use of foot and leg muscles. It is believed that when running barefoot an athlete must use all the muscles in their foot and leg to run, thus no one muscle must work harder than it was intended, as they believe is the case in those running with shoes. They say that shoes and “high-tech” athletic sneakers prohibit certain muscles in the legs from working at their maximum capacity, forcing other muscles to work harder, which could lead to the increase in energy expenditure.
Proponents of running with shoes believe that without the use of supportive shoes and/or orthotic devices during running, the musculature of the foot and leg is incorrectly aligned or stretched. Muscles function at their maximum capacity, with the least energy expenditure while in their correct anatomical alignment, so unless a person has a “perfect” foot, chances are their muscles are not functioning at the top of their game! Orthotics and shoes to some extent, place the foot and leg in their “neutral position,” aligning the muscles, tendons and ligaments correctly so as to allow them to exert their maximum benefit.
In terms of injury, it remains to be seen whether more acute injuries are suffered with or without shoes because there simply isn’t enough research to support one side or the other. However, it has been proven that the skin on the soles of the feet is 20 times thicker than any other skin on the body. This may make the sole of the foot more resistant to injury over other areas of the body, but it certainly doesn’t make it immune to injury! Those against barefoot running can show clear evidence to support an increase in puncture wounds to the soles of the feet in athletes running without shoes. Objects that could be encountered while running without shoes, such as rocks, glass and nails still have the potential to cause serious injury and debilitation to the soles.
Certainly if you suffer from peripheral neuropathy, as a complication of diabetes, alcoholism or other inducing factors, shoes should be worn at all times. In patients with neuropathy, infarct on the plantar aspects of the foot may go undetected due to lack of sensation, and further complications such as infection and non-healing wounds are imminent!
Adjusting to barefoot running, should you bravely attempt it, may take up to 4 weeks, at which time the skin on the plantar surfaces of your feet with become thicker and more adept to handling new terrain. You should begin by walking barefoot as much as possible, and slowly work your way into jogging, and eventually running when you feel comfortable.
No matter which thought process you follow, exhibit safety. Carefully weigh the options, know which is best for you, and get running!
It is not so much that you can’t become a “barefoot runner,” but the more important question becomes, is it safe? What are the risks and benefits of running without shoes?
Running barefoot has come into favor in recent years because runners and sports science researcher alike believe that running barefoot allows a runner to expend less energy in addition to decreasing their risk of acute injury, such as ankle sprains. Proponents believe that the risk of injury increases with shoe-wear due to slowed proprioceptive feedback from the foot to the brain. Proprioceptive feedback is a message sent from the foot up to the brain that tells your foot that it is on the ground and in which position. Without shoes, there is no interference from the material of the shoe and the feedback from the foot to the brain is faster and more efficient, thus your body can adjust to uneven surfaces quicker, preventing injury.
The theory behind a decrease in energy expenditure in the athletes running barefoot has no substantial research behind it, but theorist believe it may have something to do with proprioceptive feedback in addition to the simultaneous use of foot and leg muscles. It is believed that when running barefoot an athlete must use all the muscles in their foot and leg to run, thus no one muscle must work harder than it was intended, as they believe is the case in those running with shoes. They say that shoes and “high-tech” athletic sneakers prohibit certain muscles in the legs from working at their maximum capacity, forcing other muscles to work harder, which could lead to the increase in energy expenditure.
Proponents of running with shoes believe that without the use of supportive shoes and/or orthotic devices during running, the musculature of the foot and leg is incorrectly aligned or stretched. Muscles function at their maximum capacity, with the least energy expenditure while in their correct anatomical alignment, so unless a person has a “perfect” foot, chances are their muscles are not functioning at the top of their game! Orthotics and shoes to some extent, place the foot and leg in their “neutral position,” aligning the muscles, tendons and ligaments correctly so as to allow them to exert their maximum benefit.
In terms of injury, it remains to be seen whether more acute injuries are suffered with or without shoes because there simply isn’t enough research to support one side or the other. However, it has been proven that the skin on the soles of the feet is 20 times thicker than any other skin on the body. This may make the sole of the foot more resistant to injury over other areas of the body, but it certainly doesn’t make it immune to injury! Those against barefoot running can show clear evidence to support an increase in puncture wounds to the soles of the feet in athletes running without shoes. Objects that could be encountered while running without shoes, such as rocks, glass and nails still have the potential to cause serious injury and debilitation to the soles.
Certainly if you suffer from peripheral neuropathy, as a complication of diabetes, alcoholism or other inducing factors, shoes should be worn at all times. In patients with neuropathy, infarct on the plantar aspects of the foot may go undetected due to lack of sensation, and further complications such as infection and non-healing wounds are imminent!
Adjusting to barefoot running, should you bravely attempt it, may take up to 4 weeks, at which time the skin on the plantar surfaces of your feet with become thicker and more adept to handling new terrain. You should begin by walking barefoot as much as possible, and slowly work your way into jogging, and eventually running when you feel comfortable.
No matter which thought process you follow, exhibit safety. Carefully weigh the options, know which is best for you, and get running!
Wednesday, May 5, 2010
Plantar fasciitis
Plantar fasciitis is probably the most common cause of heel pain in adults. The plantar fascia is a thick band of fibrous connective tissue that attaches to the heel bone, runs across the bottom of the foot and then fans out to connect at the base of each toe (Figure 1). It provides support for the arch of the foot, helps to lift the arch during normal walking, and also acts as a shock absorber during walking and running.
Overuse of the plantar fascia, most commonly during weight-bearing athletics such as running or even extended periods of standing, can cause small, repetitive tears in the fibers that make up the fascia.
The resultant inflammation and swelling produces the pain of plantar fasciitis. Damage is most common in areas where the stress on the connective tissue is greatest and where the fascia is thinnest, as it curves around the back of the heel. Plantar fasciitis is particularly common in older people because the heel fat pad that normally protects the plantar fascia in this region thins with age. Patients with plantar fasciitis typically feel a sharp pain in the heel, particularly on rising in the morning and at the beginning of a walk or run, that may fade as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness.
Treatments for plantar fasciitis include:
• Icing
• Exercises
• Rest
• Steroid Injections
• Orthotics
• Splints
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation
Exercises are not only effective for the relief of active plantar fasciitis, but also help to minimize recurrence of this painful condition. This brochure will provide practical instruction in the use of some of these simple exercises.
EXERCISES
Exercises for recovery from or prevention of plantar fasciitis are generally divided into two types:
1) Stretching Exercises, 2) Strengthening Exercises.
STRETCHING EXERCISES
Stretching exercises are used to increase the flexibility of the muscles of the thigh and calf and of the plantar fascia itself. Tightness in the muscles of the leg can result in disproportionate stress being applied to the plantar fascia during walking and running, increasing the risk of injury. Stretching exercises for the plantar fascia itself can increase the flexibility of the fascia and thus reduce the potential for damage. Five examples of stretching exercises with illustrations follow:
A. WALL GASTROCNEMIUS STRETCH
The gastrocnemius is one of major muscle groups in the calf. To stretch this muscle, place your hands against the wall and stand with both feet flat on the floor, one foot forward of the other (Figure 2). Keep the rearmost leg straight and the foot pointed straight ahead. Lean forward without arching the back, placing your weight on the forward leg while bending it at the knee. You should feel stretching in the mid-calf of the straight leg. Hold the stretch for 10-15 seconds, release, and then repeat 6-8 times. Reverse the position of the legs and then stretch the other leg.
B. STAIR GASTROCNEMIUS STRETCH
The gastrocnemius can also be stretched using a simple exercise that can be performed while standing on a stair (Figure 3). Stand with the ball of the foot on the edge of a stair and heels off the step. While holding the banister for balance, rise as high as possible on the toes and then lower yourself slowly as far as you can without rolling the foot inward or outward for 1-2 seconds and then repeat 10-20 times.
C. SOLEUS STRETCH
The soleus is the other major muscle in the calf. To stretch this muscle, assume a position similar to that for the Wall Gastrocnemius Stretch but with both of the legs bent and the buttocks dropped (Figure 4). Make sure your feet are facing straight ahead and not turned out. Gently lean into the wall and keep your heels on the floor while bending both knees, putting a little more weight on the back leg. Continue until you feel stretching in your lower calf. Hold the stretch for 30 seconds and repeat 2-3 times on each side.
D. HAMSTRING STRETCH
The hamstring is a major muscle of the thigh that runs from just below the knee to the buttocks and lifts the lower leg and bends the knee. If the hamstring istoo tight, the bend in the knee during walking and running is exaggerated, which, in turn, results in increased pull on the heel bone and too much tension in the plantar fascia.
To stretch the hamstring, lie with your back flat to the floor with your eyes focused upward. Grasp the back of the thigh with both hands and, with the leg bent, pull the thigh until it is perpendicular to the floor and then slowly straighten the knee (Figure 5). Repeat the exercise with the other leg.
E. SEATED PLANTAR FASCIA STRETCH
During normal walking, the plantar fascia lengthens and then shortens as the foot lands. If the plantar fascia is insufficiently elastic, repetitive lengthening and shortening can result in damage to the fibers of the fascia with subsequent inflammation. Exercises that stretch the plantar fascia can improve its flexibility and help it withstand the stresses that are placed on it without damage.
The plantar fascia can be easily stretched while sitting. Sit on a chair or on the edge of a bed with one leg crossed over the other (Figure 6). Place the fingers of the hand of the same side as the crossed leg across the base of the toes and pull the toes back toward the shin while keeping the leg steady until stretch is felt in the bottom of the foot. Repeat the exercise five times for each foot. This exercise is particularly effective when done before taking the first steps of the day and after prolonged sitting or inactivity.
F. ROLLING STRETCH
The rolling stretch (Figure 7) is another simple way to stretch the plantar fascia. To perform this exercise, sit on the edge of a bed and place your foot on a hard cylindrical object such as a plastic water bottle or a ball. Roll the foot over the object while maintaining pressure against it. Continue rolling for 30-60 seconds, stop, and then repeat for a total of five times. This stretch should be performed three times per day. For pain relief while performing the exercise, use a water bottle filled with cold water or chill the ball in the refrigerator prior to performing the exercise.
STRENGTHENING EXERCISES
These exercises are designed to strengthen the muscles in the foot and ankle that support the arch of the foot. Strengthening these muscles will take stress off the plantar fascia. All of these exercises are best done barefoot. Three examples with illustrations follow:
A. TOWEL CURLS
Lay a hand towel on an uncarpeted floor and place the bare foot on the towel (Figure 8). Keeping the heel on the floor, curl the toes, pulling the towel toward you. Continue pulling the towel with the toes until it is bunched under the arch of the foot. Repeat this procedure 10 times with each foot. As your feet get stronger, resistance can be increased by placing a soup can or other weighted object on the end of the towel.
B. TOE WALKING
With your body erect and your hands behind your back, walk on your toes with the toes pointed straight ahead (Figure 9). As the foot is placed down, allow the heel to come as close as possible to the floor without touching. Then rise on the toes as high as possible before pushing off the ground. Taking very short steps, walk across the room. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.
C. HEEL WALKING
With your body erect and your hands behind your back, lift your toes as high as you can and walk across the room on your heels with the toes pointed straight ahead (Figure 10). Take very short steps and do not allow the toes to touch the ground. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.
SUMMARY
Inflammation of the plantar fascia, most commonly as a result of overuse, is a painful and potentially debilitating condition. Icing, rest, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve the pain but do little to treat the underlying causes of plantar fasciitis. Regular performance of a series of leg and foot exercises is not only an effective treatment for the pain of plantar fasciitis but also an effective deterrent for recurrence of this painful condition.
Please check with your doctor or podiatrist before starting any exercise routine.
Overuse of the plantar fascia, most commonly during weight-bearing athletics such as running or even extended periods of standing, can cause small, repetitive tears in the fibers that make up the fascia.
The resultant inflammation and swelling produces the pain of plantar fasciitis. Damage is most common in areas where the stress on the connective tissue is greatest and where the fascia is thinnest, as it curves around the back of the heel. Plantar fasciitis is particularly common in older people because the heel fat pad that normally protects the plantar fascia in this region thins with age. Patients with plantar fasciitis typically feel a sharp pain in the heel, particularly on rising in the morning and at the beginning of a walk or run, that may fade as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness.
Treatments for plantar fasciitis include:
• Icing
• Exercises
• Rest
• Steroid Injections
• Orthotics
• Splints
• Use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation
Exercises are not only effective for the relief of active plantar fasciitis, but also help to minimize recurrence of this painful condition. This brochure will provide practical instruction in the use of some of these simple exercises.
EXERCISES
Exercises for recovery from or prevention of plantar fasciitis are generally divided into two types:
1) Stretching Exercises, 2) Strengthening Exercises.
STRETCHING EXERCISES
Stretching exercises are used to increase the flexibility of the muscles of the thigh and calf and of the plantar fascia itself. Tightness in the muscles of the leg can result in disproportionate stress being applied to the plantar fascia during walking and running, increasing the risk of injury. Stretching exercises for the plantar fascia itself can increase the flexibility of the fascia and thus reduce the potential for damage. Five examples of stretching exercises with illustrations follow:
A. WALL GASTROCNEMIUS STRETCH
The gastrocnemius is one of major muscle groups in the calf. To stretch this muscle, place your hands against the wall and stand with both feet flat on the floor, one foot forward of the other (Figure 2). Keep the rearmost leg straight and the foot pointed straight ahead. Lean forward without arching the back, placing your weight on the forward leg while bending it at the knee. You should feel stretching in the mid-calf of the straight leg. Hold the stretch for 10-15 seconds, release, and then repeat 6-8 times. Reverse the position of the legs and then stretch the other leg.
B. STAIR GASTROCNEMIUS STRETCH
The gastrocnemius can also be stretched using a simple exercise that can be performed while standing on a stair (Figure 3). Stand with the ball of the foot on the edge of a stair and heels off the step. While holding the banister for balance, rise as high as possible on the toes and then lower yourself slowly as far as you can without rolling the foot inward or outward for 1-2 seconds and then repeat 10-20 times.
C. SOLEUS STRETCH
The soleus is the other major muscle in the calf. To stretch this muscle, assume a position similar to that for the Wall Gastrocnemius Stretch but with both of the legs bent and the buttocks dropped (Figure 4). Make sure your feet are facing straight ahead and not turned out. Gently lean into the wall and keep your heels on the floor while bending both knees, putting a little more weight on the back leg. Continue until you feel stretching in your lower calf. Hold the stretch for 30 seconds and repeat 2-3 times on each side.
D. HAMSTRING STRETCH
The hamstring is a major muscle of the thigh that runs from just below the knee to the buttocks and lifts the lower leg and bends the knee. If the hamstring istoo tight, the bend in the knee during walking and running is exaggerated, which, in turn, results in increased pull on the heel bone and too much tension in the plantar fascia.
To stretch the hamstring, lie with your back flat to the floor with your eyes focused upward. Grasp the back of the thigh with both hands and, with the leg bent, pull the thigh until it is perpendicular to the floor and then slowly straighten the knee (Figure 5). Repeat the exercise with the other leg.
E. SEATED PLANTAR FASCIA STRETCH
During normal walking, the plantar fascia lengthens and then shortens as the foot lands. If the plantar fascia is insufficiently elastic, repetitive lengthening and shortening can result in damage to the fibers of the fascia with subsequent inflammation. Exercises that stretch the plantar fascia can improve its flexibility and help it withstand the stresses that are placed on it without damage.
The plantar fascia can be easily stretched while sitting. Sit on a chair or on the edge of a bed with one leg crossed over the other (Figure 6). Place the fingers of the hand of the same side as the crossed leg across the base of the toes and pull the toes back toward the shin while keeping the leg steady until stretch is felt in the bottom of the foot. Repeat the exercise five times for each foot. This exercise is particularly effective when done before taking the first steps of the day and after prolonged sitting or inactivity.
F. ROLLING STRETCH
The rolling stretch (Figure 7) is another simple way to stretch the plantar fascia. To perform this exercise, sit on the edge of a bed and place your foot on a hard cylindrical object such as a plastic water bottle or a ball. Roll the foot over the object while maintaining pressure against it. Continue rolling for 30-60 seconds, stop, and then repeat for a total of five times. This stretch should be performed three times per day. For pain relief while performing the exercise, use a water bottle filled with cold water or chill the ball in the refrigerator prior to performing the exercise.
STRENGTHENING EXERCISES
These exercises are designed to strengthen the muscles in the foot and ankle that support the arch of the foot. Strengthening these muscles will take stress off the plantar fascia. All of these exercises are best done barefoot. Three examples with illustrations follow:
A. TOWEL CURLS
Lay a hand towel on an uncarpeted floor and place the bare foot on the towel (Figure 8). Keeping the heel on the floor, curl the toes, pulling the towel toward you. Continue pulling the towel with the toes until it is bunched under the arch of the foot. Repeat this procedure 10 times with each foot. As your feet get stronger, resistance can be increased by placing a soup can or other weighted object on the end of the towel.
B. TOE WALKING
With your body erect and your hands behind your back, walk on your toes with the toes pointed straight ahead (Figure 9). As the foot is placed down, allow the heel to come as close as possible to the floor without touching. Then rise on the toes as high as possible before pushing off the ground. Taking very short steps, walk across the room. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.
C. HEEL WALKING
With your body erect and your hands behind your back, lift your toes as high as you can and walk across the room on your heels with the toes pointed straight ahead (Figure 10). Take very short steps and do not allow the toes to touch the ground. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.
SUMMARY
Inflammation of the plantar fascia, most commonly as a result of overuse, is a painful and potentially debilitating condition. Icing, rest, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve the pain but do little to treat the underlying causes of plantar fasciitis. Regular performance of a series of leg and foot exercises is not only an effective treatment for the pain of plantar fasciitis but also an effective deterrent for recurrence of this painful condition.
Please check with your doctor or podiatrist before starting any exercise routine.
Plantar Fasciotomy
Plantar Fasciotomy is an Option in Only 5% of Plantar Fasciitis Patients
Over the last several weeks we have been discussing Plantar Fasciitis and treatment options for alleviating symptoms. The reason so much time has been spent discussing this topic is because plantar fasciitis is extremely common, seen in about 50% of new patients presenting to a Podiatrist’s office. The upside to the high prevalence of plantar fasciitis is that in 95% of patients who have “heel pain,” conservative treatment methods will result in success!
To recap, plantar fasciitis is an irritation of a band of tissue on the bottom of your foot extending from the heel into the toes. When this band of tissue is stretched in the wrong direction, or is too short to stretch correctly, it becomes irritated and inflamed causing heel pain. The most clinically indicative symptom of plantar fasciitis is pain in the morning, with the first step out of bed that lessens during the day with activity. The reason patients experience this “first step” pain is because as they were sleeping the plantar fascia started to repair itself, essentially shortening, and with that first step, it is stretched again and micro-tears in the tissue occur.
A few of the conservative options we touched on included: stretching exercises, supportive and constantly worn shoes, injection therapy to help break the chronic inflammatory cycle, and oral anti-inflammatory medications. Last week we discussed Acoustic Shock Wave Therapy for treatment of chronic plantar fasciitis after a 6-month period of failure with treatment using other conservative options. Shock Wave Therapy is a conservative method of treatment in that there are no surgical incisions, but it is slightly more aggressive than other conservative options and is thus reserved for specific patients.
With failure of all conservative options, including Shock Wave Therapy, in patients with long-standing plantar fasciitis/heel pain, it is likely that surgery will be discussed as an option. Keep in mind that the conversation of surgical intervention will only occur in 5% of patients with plantar fasciitis, so surgical intervention is rarely required! The goal of surgery is to relieve the plantar fascia of the tension that is residing within it, providing relief to the patient. There are surgical options that are in favor at this time, each achieving that goal in a slightly different way.
One option, called an Open Plantar Fasciotomy, is simply what it sounds like. Your Podiatric Surgeon will make a small incision along the heel, visualize the plantar fascia and release it near its origin in the heel bone. A calcaneal spur, should one be present, may also be removed during the procedure. The decision as to whether or not to remove a calcaneal spur (an area of extra bone growth along the heel bone from plantar fascial pull) will be made prior to surgery by your Podiatrist using x-ray evaluation. The procedure is done in an outpatient setting, meaning you will be able to go home and relax immediately following surgery. You will be restricted from placing pressure on the heel for at least a week and you should expect some normal pain and swelling in and around the heel. Ice and pain medication prescribed to you will help to alleviate some of these symptoms. As your body heels from surgery, the area where the plantar fascia was released will fill in with new tissue growth, essentially lengthening the plantar fascia and relieving tension in the tissue. With the added length, the fascia is no longer too short to accommodate for the stretch it was meant to achieve!
An Endoscopic Plantar Fasciotomy is a slightly less invasive procedure than the Open Plantar Fasciotomy, but it also aims to relieve tension on the plantar fascia and allow your body to fill in with new tissue, lengthening the fascia. This procedure utilizes a small camera for visualization of the plantar fascia, with two small incisions rather than one larger incision. The procedure is completed in an outpatient setting with the post-operative instructions being the same as with the “open” procedure, although slightly less recovery time is needed.
Finally, one less available and infrequently performed procedure utilizes “Autologous Platelet Concentration.” Essentially, what that concentration is made up of, is cells and healing factors from your own blood that have been spun down into a syringe. The concentration will be injected into the heel under ultrasound visualization of the plantar fascia, with the goal of the procedure to stimulate healing to decrease thickness of the plantar fascia tissue, essentially alleviating the symptoms of fasciitis. You will be casted for several days to eliminate any chance of pressure on the heel, and once those few days have elapsed you will be transitioned back into a sneaker.
Remember that no surgical procedure is without its risks; therefore both benefits and risks of the surgery should be discussed with your Podiatrist prior to consenting to a procedure. For these specific procedures you must understand that recurrence of pain to the plantar heel is possible as well as a very low possibility of infection, destabilization of the lateral foot, neve entrapment and heel bone fracture. In addition, you will still need to implement conservative and preventative treatment measures such as proper and supportive shoes and stretching of the musculature to maintain your surgical results!
_____________
Enjoy Running? Stay tuned as next week we will tackle the topic!
Over the last several weeks we have been discussing Plantar Fasciitis and treatment options for alleviating symptoms. The reason so much time has been spent discussing this topic is because plantar fasciitis is extremely common, seen in about 50% of new patients presenting to a Podiatrist’s office. The upside to the high prevalence of plantar fasciitis is that in 95% of patients who have “heel pain,” conservative treatment methods will result in success!
To recap, plantar fasciitis is an irritation of a band of tissue on the bottom of your foot extending from the heel into the toes. When this band of tissue is stretched in the wrong direction, or is too short to stretch correctly, it becomes irritated and inflamed causing heel pain. The most clinically indicative symptom of plantar fasciitis is pain in the morning, with the first step out of bed that lessens during the day with activity. The reason patients experience this “first step” pain is because as they were sleeping the plantar fascia started to repair itself, essentially shortening, and with that first step, it is stretched again and micro-tears in the tissue occur.
A few of the conservative options we touched on included: stretching exercises, supportive and constantly worn shoes, injection therapy to help break the chronic inflammatory cycle, and oral anti-inflammatory medications. Last week we discussed Acoustic Shock Wave Therapy for treatment of chronic plantar fasciitis after a 6-month period of failure with treatment using other conservative options. Shock Wave Therapy is a conservative method of treatment in that there are no surgical incisions, but it is slightly more aggressive than other conservative options and is thus reserved for specific patients.
With failure of all conservative options, including Shock Wave Therapy, in patients with long-standing plantar fasciitis/heel pain, it is likely that surgery will be discussed as an option. Keep in mind that the conversation of surgical intervention will only occur in 5% of patients with plantar fasciitis, so surgical intervention is rarely required! The goal of surgery is to relieve the plantar fascia of the tension that is residing within it, providing relief to the patient. There are surgical options that are in favor at this time, each achieving that goal in a slightly different way.
One option, called an Open Plantar Fasciotomy, is simply what it sounds like. Your Podiatric Surgeon will make a small incision along the heel, visualize the plantar fascia and release it near its origin in the heel bone. A calcaneal spur, should one be present, may also be removed during the procedure. The decision as to whether or not to remove a calcaneal spur (an area of extra bone growth along the heel bone from plantar fascial pull) will be made prior to surgery by your Podiatrist using x-ray evaluation. The procedure is done in an outpatient setting, meaning you will be able to go home and relax immediately following surgery. You will be restricted from placing pressure on the heel for at least a week and you should expect some normal pain and swelling in and around the heel. Ice and pain medication prescribed to you will help to alleviate some of these symptoms. As your body heels from surgery, the area where the plantar fascia was released will fill in with new tissue growth, essentially lengthening the plantar fascia and relieving tension in the tissue. With the added length, the fascia is no longer too short to accommodate for the stretch it was meant to achieve!
An Endoscopic Plantar Fasciotomy is a slightly less invasive procedure than the Open Plantar Fasciotomy, but it also aims to relieve tension on the plantar fascia and allow your body to fill in with new tissue, lengthening the fascia. This procedure utilizes a small camera for visualization of the plantar fascia, with two small incisions rather than one larger incision. The procedure is completed in an outpatient setting with the post-operative instructions being the same as with the “open” procedure, although slightly less recovery time is needed.
Finally, one less available and infrequently performed procedure utilizes “Autologous Platelet Concentration.” Essentially, what that concentration is made up of, is cells and healing factors from your own blood that have been spun down into a syringe. The concentration will be injected into the heel under ultrasound visualization of the plantar fascia, with the goal of the procedure to stimulate healing to decrease thickness of the plantar fascia tissue, essentially alleviating the symptoms of fasciitis. You will be casted for several days to eliminate any chance of pressure on the heel, and once those few days have elapsed you will be transitioned back into a sneaker.
Remember that no surgical procedure is without its risks; therefore both benefits and risks of the surgery should be discussed with your Podiatrist prior to consenting to a procedure. For these specific procedures you must understand that recurrence of pain to the plantar heel is possible as well as a very low possibility of infection, destabilization of the lateral foot, neve entrapment and heel bone fracture. In addition, you will still need to implement conservative and preventative treatment measures such as proper and supportive shoes and stretching of the musculature to maintain your surgical results!
_____________
Enjoy Running? Stay tuned as next week we will tackle the topic!
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